Wednesday, May 30, 2018

When I was maybe five a doctor friend
of my parents, Arthur Shapiro, gave me a stethoscope he was finished with. I was
thrilled – not about putting the plugs in my ears and listening, but by having a
real object, a fetish from the grownup world. Next to that my toy doctor's kit
with its little bottle of pink sugar pills paled by comparison.

Drawing by Suzanne Dunaway

For checkups my
brother and I would get driven all the way from Flushing across the 59th Street
Bridge to the pediatrics department in the white towers of New York Hospital. All
I remember about Dr. Fraad* is he once reassured my mother about my baby toenail
that she thought was growing in funny. Sixty years later I showed her the same
toenail and she was still unconvinced.

Most of the time I kind of liked
being sick. Sickness turned on my mother’s Fair Illness Code. You got to eat
apple sauce with pills crushed up inside, if you had a fever of 100° you got to
stay home from school, and after the fever was gone you had a right to one
extra day at home. Once during a high fever I hallucinated climbing a huge
mountain without ever getting to the top, like Sisyphus with his stone, and I remember
I considered it great fun – delirium as a natural psychedelic.

But once when I had an earache I
remember my mother weeping helplessly at my bedside. I must have been howling
in pain myself, but the sight of her in tears was so astonishing that it’s all
that’s stuck in my memory. The torment of another earache stuck in memory as an
engulfing red ball that expanded bigger and bigger. The doctor came to the
house, I can still see him looming over my bed, but the pain only stopped when
my eardrum burst the next day. I found it wonderful to have no hearing from my
right ear, and kept rubbing the outside to test it.

Medicine didn’t have much of a
presence in my young universe, but expatriation did. Many of our family friends
had fled the Nazis, and as Jews by origin if not religion my parents always kept
their mental bags half-packed for a quick exit. Which is why my father once
suggested that I should become a doctor, advice I scorned for decades. His reasoning
was that – in the worst case scenario – I could instantly set up shop as a
physician anywhere in the world. He didn’t, needless to say, know Italian
bureaucracy!

*added October 12, 2018:
An
email from a reader set me to googling Dr. Fraad. I learned from his New York
Times obituary
that he was indeed distinguished enough to be worth the trip across the bridge –
Benjamin Spock cited him as an influence – and that he was an active left-winger,
possibly a Communist,
instrumental in sparking the famous 1969-71 health workers’ collective at Lincoln Hospital
in the Bronx. You can hear him speakhere, very
near the beginning.

Saturday, May 12, 2018

One
day late in 1969, in a back office of Creedmoor psychiatric hospital in Queens,
I hiked up my skirt and pulled down my tights. My boss Dr. Gideon Seaman,
knowing I would soon be taking off for eight months in Europe, had brought
along a huge syringe of gamma globulin and shot that horse dose of protective
antibodies into the front of my thigh as I stood in front of him. I fell back
onto a chair, passed out from the pain.

What
country was he protecting me against?
Italy. Why? Because, he said, it’s crawling with hepatitis. The locals would
pick up the “infectious” A variety from eating their beloved mussels and clams
– they were harvested from polluted waters and cooked, if at all, too briefly
to kill any lurking viruses. The “serum” B kind they picked up from
mothers as mere tots, preparing them to pass it on as adults through needles
and sex; any guy I might pick up would likely have been infected since he was
four. (If medical science had known about the C kind of hepatitis at the time –
it didn’t – it would have also known that too was big in Italy.)

Today the shoe is on
the other foot. Americans are much likelier than Italians to die of infections,
mostly because of poor access to health care – not to speak of Italy’s
conversion to farmed rather than wild shellfish. Former sins have left their
mark on Italy, though, in that several key vaccines reached here decades after
they became standard in the States. More cases of measles and congenital German
measles are reported in Italy than in any other Western European country, with the
number skyrocketing
between 2016 and 2017 thanks to a know-nothing “No Vax” movement. And things
may get worse: the measles vaccination rate for Italian toddlers fell steadily
between 2010 and 2016.

My world-hopping clients
often need to attend public travel clinics, which have a monopoly on vaccines
against yellow fever and Japanese encephalitis. For decades this was a piece of
cake: I wrote a prescription and an address, the patient showed up at the
clinic any weekday between 9 and 12, and walked out a half hour later ten
dollars poorer, with wisps of cotton taped to their arms. It was a poster child
for public medicine. Now the party’s over – in 2013 my beloved vaccinators
simultaneously started requiring appointments and stopped answering the phone.

Let me close with the strange case of
tetanus. There are 400,000 horses in Italy and they are often healthy carriers
of tetanus spores, including the ones you see roving the streets of Rome or
Florence with police on their backs. Many of these healthy-looking animals
gaily deposit manure laced with tetanus spores on the pavement, manure that
then patiently waits for a passer-by to get injured so the spores can enter the
body, wake up, and multiply. Italians now over fifty weren’t vaccinated as children, nor
were most immigrants, so plenty of the people who show up in Italian Emergency
Rooms with contaminated wounds should by rights receive not just a tetanus booster
but also a shot of antiserum – a type of immune globulin hyper-packed with
tetanus antibodies.

But as far as I know that antiserum has never once
been administered, in any Rome hospital, to a single patient of mine. Emergency
Room physicians go to great lengths to avoid giving it. They’ll tell patients
that antiserum is no good two days after the injury (nope – it works even after
three weeks). They’ll branish consent forms that claim it can transmit AIDS
(possible in theory but nonexistent in practice). They’ll say tetanus was
eradicated long ago (would that it were). Why those docs put up so much
resistance is a mystery but it may be merely that the hospitals don’t keep the
perishable antiserum in stock. An Italian team that studied tetanus prophylaxis in Naples’s public
hospitals just a few years ago concluded, “Only 1.5% of the physicians
correctly adhere to guidelines.” The upshot? More than a third of the cases of
tetanus in the European Union occur in Italy, with 60 fatalities a year. So be
forewarned: odd though it may sound for an otherwise proudly developed nation,
Italy is one of those countries where you’ll want to make sure your tetanus
vaccinations are up to date.

By tradition Italians consider wine
and beer to be foods, not drugs, knocked back to enhance a meal rather than to
get soused. When I was first getting invited to dinner in Italian homes, in
1970, the children would be served acquavino,
water laced with a few drops of wine. I’m convinced this non-medical homeopathy
innoculated them against later dipsomania. Those old habits have by and large
held up nicely, but very recently some young Italians have started to imitate
the tourists in their midst by converting to the northern European cult of
Saturday night drunkenness. Let’s hope it’s just a fad.

As with many American phenomena that
favor the all-or-nothing (think Tesla vs. SUV), the United States is overloaded
with problem drinkers on the one hand and teetotalers on the other. I sip my
way through two glasses of wine every evening with supper, more alcohol than 95%
of American women.

Alcoholic beverages are sold in every
Rome supermarket and at every corner store, at all hours. The exception is
before a soccer match if the Rome or Lazio team is playing against an adversary
with notoriously hard-drinking fans, such as Manchester United, in which case
City Hall has been known to institute temporary bans in the attempt to keep hordes
of drunken Englishmen from taking over the streets.

(Curiously, a horde of drunken
Italians is something of a contradiction in terms. Liquored up Romans get
cheerful and friendly, not raucous and rowdy. Turns out the way people act when
they’ve been imbibing is due at least as much to cultural expectation as to the
pharmacological effect of alcohol.)

You’re supposed to be 18 to buy, but
this being Italy nobody at the checkout counter is checking IDs. When American
“abroad” college students catch on, they tend to go off the deep end and can land
in deep trouble – since I’ve lived here a half dozen are known to have fallen to
their deaths out of windows, from bridges, or off walls, and that’s not
counting the cases that have been hushed up.

A small glass of wine every day
throughout pregnancy doesn’t cause fetal alcohol syndrome or anthing else, by
the way, contrary to the prohibitionist terror campaign in the United States.
Every adult Italian you see on the street was exposed to it and survived.

About Me

I moved to Rome in 1978 after finishing my training in New York, and have been practicing primary care internal medicine there ever since, treating a clientele that’s featured Roman auto mechanics and British ambassadors, Indonesian art restorers and Filipina maids, Russian poets and Ethiopian priests. When not seeing patients, doing research in psychosomatic medicine, or being the Artist's Wife to my composer husband, I've written a book about my medical adventures, Dottoressa: An American Doctor In Rome, to be published by Paul Dry Books in May 2019.